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Comparison of reticulocyte hemoglobin equivalent with traditional markers of iron and erythropoiesis in pediatric dialysis

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Abstract

Background

Anemia is a major complication for patients on chronic dialysis. Erythropoietin is effective if iron is available, however unnecessary iron supplementation results in iron overload. Reticulocyte hemoglobin equivalent (Ret-He) may be useful for assessing iron status.

Methods

A national retrospective cohort study including all children on chronic dialysis in New Zealand between 2007 and 2013, pairing Ret-He with demographic information, anemia indices, and markers of iron status.

Results

In 606 observations, we found a modest relationship between Ret-He and transferrin saturation (TSAT) (r = 0.34, p < 0.001) and a poor correlation between Ret-He and ferritin (r = 0.09, p = 0.04). There was a negative correlation between ferritin and hemoglobin (r = −0.14, p = 0.002), a weak positive correlation between TSAT and hemoglobin (r = 0.12, p = 0.007), and a modest positive correlation between Ret-He and hemoglobin (r = 0.22, p < 0.001). The diagnostic performance of Ret-He to detect absolute iron deficiency (cut-off value 28.9 pg, sensitivity 90 %, specificity 75 %, AUC 0.87) was good.

Conclusions

Ret-He is a more relevant marker of iron status than ferritin and TSAT. This supports prospectively testing Ret-He to distinguish between iron deficiency and suboptimal erythropoietin dosing as competing causes for anemia. Ferritin is an unhelpful biomarker of iron deficiency in this setting.

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Acknowledgments

We would like to acknowledge Jane Ronaldson, renal nurse specialist at Starship Hospital for her continued data collection efforts and exemplary care provided to our children needing dialysis.

Study approval

Institutional ethical approval was obtained from the Auckland District Health Board research review office with a waiver of patient informed consent requirement due to the retrospective nature of the study.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Starship Children’s Hospital, Auckland, New Zealand

    Sarka Davidkova

  2. Blood and Cancer Centre, Starship Children’s Hospital, Auckland, New Zealand

    Timothy D. Prestidge

  3. Children’s Research Centre, Starship Children’s Hospital, Auckland, New Zealand

    Peter W. Reed

  4. Department of Nephrology, Starship Children’s Hospital, Park Road, Private Bag 92024, Auckland, 1142, New Zealand

    Tonya Kara, William Wong & Chanel Prestidge

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  1. Sarka Davidkova
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  2. Timothy D. Prestidge
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Correspondence to Chanel Prestidge.

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Davidkova, S., Prestidge, T.D., Reed, P.W. et al. Comparison of reticulocyte hemoglobin equivalent with traditional markers of iron and erythropoiesis in pediatric dialysis. Pediatr Nephrol 31, 819–826 (2016). https://doi.org/10.1007/s00467-015-3284-2

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  • DOI: https://doi.org/10.1007/s00467-015-3284-2

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